2504_Ch17_657-676.qxd 10/28/10 1:10 PM Page 657 17 Cultural Nursing and and Alternative Health Care Remember that our nation s first great leaders were also great scholars. John F. Kennedy The use of alternative therapies to treat specific disorders and to promote health and wellbeing has increased in recent years. Many people use herbs, massage therapy, aromatherapy, rolfing, guided imagery, yoga, and numerous other techniques either alone or in addition to the techniques and drugs used by conventional medicine. The nurse should be aware of these practices and of the various health-related beliefs and traditions that people of different cultures have. KEYWORDS ABBREVIATIONS ayurveda curandero mezuzah nattuvidhyar rolfing tallis Yom Kippur Acquired Immunodeficiency Syndrome (AIDS) Activities of Daily Living (ADLs) Blood Pressure (BP) Complementary and Alternative Medicine (CAM) Health-Care Provider (HCP) International Normalized Ratio (INR) National Center for Complementary and Alternative Medicine (NCCAM) Nonsteroidal Anti-Inflammatory Drug (NSAID) Unlicensed Assistive Personnel (UAP) PRACTICE QUESTIONS 1. The nurse is admitting the client to a medical unit. Which questions should the nurse specifically ask the client about the current use of medications? Select all that apply. 1. Have you used or do you currently use any type of herb? 2. What over-the-counter medications do you take? 3. Are you allergic to any medications or foods? 4. When is the last time you took any medication? 5. Do you take any prescription medications? 657
658 MED-SURG SUCCESS 2. The client who has had a cold for the last week is complaining of congestion and a stuffy nose. The client has been using medicated nasal spray several times a day. Which information should the nurse teach the client about frequent use of nasal spray? 1. Nasal sprays are safe because they are available over the counter. 2. Nasal sprays such as Afrin cause rebound congestion when used frequently. 3. Nasal sprays have no adverse reactions, unlike over-the-counter oral decongestants. 4. Nasal sprays must be alternated to help prevent developing a tolerance to the spray. 3. The client using contraceptive foam for birth control has not had her menses for the last two (2) months. Which intervention should the nurse implement first? 1. Perform a vaginal examination. 2. Check the urine for glucose and protein. 3. Obtain vital signs to determine a baseline. 4. Request a pregnancy test for this client. 4. The female client with a cold is prescribed warfarin (Coumadin), an anticoagulant, for chronic atrial fibrillation. The client calls the clinic and tells the nurse she is bleeding and bruising more than normal. Which information indicates a need for further teaching? 1. The client reports taking echinacea, an herb. 2. The client had an INR drawn last month. 3. The client uses acetaminophen, a nonopioid analgesic, for pain. 4. The client reads labels on packaged foods. 5. Which intervention should the nurse implement when discussing health promotion activities for a client with a German heritage who leads a sedentary lifestyle? 1. Refer the client to a support group for weight loss. 2. Teach the client to never drink alcoholic beverages. 3. Help the client to identify a routine exercise program. 4. Assist the client to make a list of foods which must be avoided. 6. The elderly female client of Mexican heritage is upset and tells the nurse the unlicensed assistive personnel (UAP) complimented her grandchild s hair. Which intervention should the nurse implement? 1. Ask the client why she is upset about the UAP s saying the child s hair is pretty. 2. Take no action because the unlicensed assistive personnel was being friendly. 3. Notify the psychologist of the client s response to the UAP s compliment. 4. Explain to the UAP about the cultural belief regarding the evil eye. 7. The home health care nurse is visiting an elderly African American female client who is talking loudly. The client weighs 102 kg, is 5 4 tall, and has a BP of 154/98. The client lives with her daughter, son-in-law, and two grandchildren. Which intervention should the nursing implement? 1. Maintain extended direct eye contact during the interview. 2. Address what is assumed to be the client s anger because she is talking loudly. 3. Discuss the client s care with the daughter and son-in-law. 4. Discuss a weight-loss program for the client. 8. The home health nurse is making the initial visit to a 42-year-old male client with terminal cancer. The client is first-generation American-Vietnamese and lives with his parents, wife, and three children. Which behavior would best promote a therapeutic nurse client relationship? 1. Use questions which require yes and no answers when possible. 2. Touch the client s head to assess warmth in case of a fever. 3. Assume the client s smile means the client understands the teaching. 4. Initially address conversation to the eldest family member.
CHAPTER 17 CULTURAL NURSING AND ALTERNATIVE HEALTH CARE 659 9. When interviewing the client of Hindu heritage, which information should the nurse obtain to plan culturally sensitive care? 1. Determine if the client has an advance directive. 2. Assess the extent of the client s use of ayurveda. 3. Request an interpreter to obtain the client s chief complaints. 4. Inquire if the client has allergies to any foods or medications. 10. The unlicensed assistive personnel (UAP) notices a strange amulet pinned to the client s gown and offers to remove it. The client does not want it removed. Which rationale should the nurse give the UAP for allowing the client to continue to wear the amulet? 1. The client is superstitious and may become distressed if it is removed. 2. The amulet is a silly trinket which won t hurt the client in any way. 3. The client brought the amulet because it gives the client emotional support. 4. The amulet is worthless and no one would try to steal it if it stays on the gown. 11. After evaluating the meal tray of a Jewish client, the nurse notices the client ate none of the meal. Which intervention should the nurse implement first? 1. Request the client s family bring meals the client can eat. 2. Contact the dietary department and request a kosher meal. 3. Notify the local rabbi to request meals be provided for the client. 4. Determine why the client is not eating any of the meal. 12. The client approaches the nurse about a weight-loss program. Which complementary therapy should the nurse suggest to assist the client s plan? 1. Music therapy. 2. Hypnotherapy. 3. Hatha yoga. 4. Alexander technique. 13. The nurse is incorporating complementary therapies in the routines of residents of a long-term care facility. Which information should the nurse consider when matching the clients with the therapy? Select all that apply. 1. The client s preferences. 2. The client s likes and dislikes. 3. The benefits obtained from the therapy. 4. The significant other s concerns. 5. The client s ability to perform therapies. 14. Which form of complementary therapy should the nurse encourage as a relaxation technique for the anxious elderly client admitted for surgery? 1. Meditation. 2. Deep breathing. 3. Rolfing. 4. Scented candle. 15. The nurse is preparing the plan of care for the client diagnosed with migraine headaches. Which information regarding complementary therapies should the nurse include in this plan? 1. Encourage the use of therapeutic touch. 2. Purchase a textbook on autogenic therapy. 3. Explain how to perform massage therapy. 4. Discuss the need to avoid aromatic oils. 16. The rehabilitation nurse is caring for an elderly client who had a surgical repair of a fractured hip. The client states she misses her dog. Which intervention should the nurse implement? 1. Put the television on a show with animal performers. 2. Arrange for the family to bring the client s dog for a visit. 3. Arrange for the client to have a visit from the pet therapy dog. 4. Share the client s feelings are completely understood by the nurse.
660 MED-SURG SUCCESS 17. The nurse is caring for a client in the rehabilitation unit who is hearing impaired, is anxious, and has elevated blood pressure. The client enjoys pet therapy but is allergic to dogs and cats. Which intervention should the nurse implement? 1. Administer antihistamine medication prior to pet therapy. 2. Spend extra time visiting at the client s bedside. 3. Arrange for a volunteer to bring the client a radio. 4. Provide a colorful fish in a small bowl for the client. 18. The nurse arranges for a dance movement therapist to lead a group session for clients with osteoarthritis. Which statement best describes the rationale for this intervention? 1. Participants in dance movement form a unique bond while moving in unison. 2. Dancing will help increase the amount of synovial fluid in the affected joints. 3. Dance therapy helps decrease the client s pain in inflamed joints. 4. Dancing causes the release of endorphins and helps the clients deal with pain. 19. The nurse is providing preoperative teaching about pain management techniques for the client having surgery. The client has a history of drug abuse. What should the nurse include in this client s plan of care? 1. The nurse should know these clients always require too much nursing care. 2. The client should select two (2) alternate therapies to replace medications. 3. The client should receive complementary therapies in addition to medications. 4. The nurse should plan to administer a double dose of medication to this client. 20. Which intervention should the circulating nurse implement for the preoperative elderly client who is anxious and diaphoretic? 1. Play soft, slow-beat music in the operating room. 2. Encourage the client to take rapid, shallow breaths. 3. Continue to talk to the client to promote relaxation. 4. Open the door to the operating suite to increase the airflow. 21. The unlicensed assistive personnel (UAP) is bathing a client who is comatose and the radio is playing current rock music. The client has tachycardia and elevated blood pressure. Which intervention should the nurse implement? 1. No action by the nurse is indicated in this situation. 2. Instruct the unlicensed assistive personnel to select baroque music. 3. Administer medication to decrease the client s heart rate and blood pressure. 4. Assist the UAP to turn the client into the lateral position. 22. The nurse is caring for the surgical client who is experiencing pain at a 4 on a 1-to-10 pain scale and is receiving pain medication via patient-controlled analgesia (PCA). Which intervention should the nurse implement first to assist the client s pain management? 1. Notify the health-care provider to increase the dosage of medication. 2. Inform the client to relax and the medication will relieve the pain soon. 3. Assist the client to perform guided imagery to increase relaxation. 4. Instruct the family member to continue to push the button for the medication. 23. Which expected outcome should be included in the plan of care for a postoperative client practicing guided imagery? 1. The client will have a decreased white blood cell count. 2. The client will report a decrease in pain using the pain scale. 3. The client will have a urine output of 360 ml each shift. 4. The client will have no drainage on the surgical dressing.
CHAPTER 17 CULTURAL NURSING AND ALTERNATIVE HEALTH CARE 661 24. The nurse is teaching the client how to use guided imagery. Which information would indicates the teaching has been effective? 1. The client closes both eyes and makes a one-syllable sounding chant. 2. The client rubs the right arm in firm stroking motions. 3. The client selects meaningful music which has 50 beats per minute. 4. The client visualizes a scene from a favorite place. 25. The client is complaining of nonspecific body aches, congestion, and coughing. The client s blood pressure is elevated. Which intervention should the nurse implement first? 1. Instruct the client to decrease salt in the diet. 2. Notify the HCP to request an antihypertensive medication. 3. Determine if the client takes any over-the-counter medication. 4. Discuss the long-term effects of atherosclerosis and hypertension.